MEDICARE: DANA LASARA RAINES AGACNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LC0200X	Critical Care Medicine Nurse Practitioner	5012391	NC
2	363LG0600X	Gerontology Nurse Practitioner	5012391	NC
3	363LA2100X	Acute Care Nurse Practitioner	5012391	NC
4	363L00000X	Nurse Practitioner	5012391	NC

General Provider Information

NPI Number	:	1790327856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA LASARA RAINES AGACNP-BC

Provider Business Mailing Address
First Line	:	508 AUBURN SQUARE DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-8229
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	170 MANNING DRIVE CB# 7025
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27599-4220
Country	:	US
Telephone Number	:	919-966-8178
Fax Number	:	919-843-4999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2019
Last Update Date	:	08/02/2024

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